PSYC 514

Question 1

SAD Persons

Answer 1

What: This is discussed in ethics and professional issues in counseling and is a part of assessing suicidality. It is an acronym used to aid in clinical judgment to assess the suicide risk of a client. In each part of the acronym, the client will receive either 1 or 0 points depending on their response. S- Sex, A- Age, D- depression, P- previous attempt, E- ethanol, R- rational thinking loss, S-social support lacking, O- organized plan, N- no partner, S- Sickness. Each risk factor is a point. 0-2 is send home with appropriate follow-up, 3-6 admit or discharge with appropriate follow-up, 7-10 admit to hospital
Why: This model does not consider a variety of personal variables, but it is a very good model to base your assessment on. This should be used in combination with clinical judgment.
EX: A patient of yours mentions suicidal thoughts. He is single, 24 years old, is currently experiencing a depressive episode, drinks every day, and recently moved far from his friends and family. According to SAD PERSONS, he scores a 6 and you try to assess whether or not the patient has a plan before deciding to hospitalize.

Question 2

Assent vs Consent to Treatment

Answer 2

What: Assent is the agreement of someone not able to give legal consent to participate in an activity i.e. therapy. Assent occurs when the therapist makes sure the child understands the therapy process at a developmentally appropriate level & has them provide their assent to treatment, or willingness to participate in therapy. Individuals who have reached the legal age of consent (18 in the US) can consent to treatment. People who cannot legally consent to treatment can assent to treatment when it is explained at their developmental level
Why: It is important to know what factors make someone able to consent.
EX: Carly, who is 12 years old is brought into treatment for behavior problems in school. The parents must provide written and verbal consent to the treatment, while the therapist explains to Carly what the treatment will entail and she can verbally agree or give assent as she is under 18.

Question 3

Bartering of Clinical Services

Answer 3

What: Bartering refers to exchanging therapy for some non-monetary good or service from a client. Bartering is a boundary crossing/violation and should be carefully considered in advance. If a counselor decides to barter, they should draw up a contract detailing the terms of the agreement in advance. It should be clearly written and agreed upon between the therapist and client.
Why: This is important because it is a type of boundary crossing. Clinicians can only barter if it does not result in exploitation or harm, if the client requests it or if such arrangements is an accepted practice among the community.
EX: Gina can’t afford to pay for therapy services but is a landscaper, so she and her therapist decide she will take care of the therapist’s lawn in exchange for therapy.

Question 4

Basic Purpose of Ethical Practice

Answer 4

What: Primary purpose of ethical practice is to safeguard client’s well-being. Also to safeguard the public. The guiding principles of ethical practice: autonomy, beneficence, nonmaleficence (to not inflict harm intentionally), & justice can assist clinicians in this endeavor. (A,B,N,J).
Why: It is important to keep this guideline in mind as we navigate through each client’s situation for example, when to break confidentiality.
EX: If a therapist is experiencing burnout, they should take a mental health day or consult to protect their clients well-being in order not to potentially inflict harm

Question 5

Confidentiality

Answer 5

What: Confidentiality is an obligation to keep information discussed in counseling private. There are a few exceptions: risk harm to self or others, abuse to a vulnerable population (developmental issues, children, elders), and a court subpoena.
Why: It is important to know when and when not to break confidentiality as it can damage the therapeutic alliance if not done correctly. It is also important to mention this during the informed consent process to be as transparent as possible.
EX: If a client expresses that they are suicidal and have an active plan to kill themselves, the therapist can break confidentiality and report them to an inpatient facility.

Question 6

Confidentiality in Group or Marital Counseling

Answer 6

What: Confidentiality in group and marital counseling is fundamentally different from confidentiality in individual treatment. The therapist must still maintain confidentiality outside of this group, but there is no guarantee other members of the group or marriage will keep information about other parties confidential. Additionally, in marital counseling the therapist should make it clear that there can be no secrets. Keeping secrets can harm the therapeutic alliance.
Why: To avoid any issues, it is important to be transparent and disclose this information to all parties involved in counseling, so everyone is aware of the expectations.
EX: In marriage counseling, the husband tells the therapist that he is having an affair when the wife is out of the room. The therapist shares that there are no secrets and will need him to tell his wife, or he will tell the wife to make sure treatment can be done properly.

Question 7

Counselor Competency

Answer 7

What: Ability to perform according to the standards of the profession involving knowledge, technical skills, and emotional competence. Practicing within the scope of your education, skills, training and experience. Staying up to date with practices by continuing education credits
Why: A clinician’s training and ability to execute modality as well as physical/mental stability and wellness are important aspects of competence. This is important because counselors must uphold these standards in order to provide the best service and do no harm to the clients.
EX: Fred is a CBT therapist and a client comes in with BPD. He decides to refer her out as he is not certified in DBT and equipped to treat out of his scope

Question 8

Direct Liability

Answer 8

What: A counselor is directly liable or legally responsible for any actions they take with a client. In other words, the counselor’s license is what’s at stake when they are delivering therapeutic services. A counselor is directly liable or legally responsible for any actions they take with a client. In other words, the counselor’s license is what’s at stake when they are delivering therapeutic services. A supervisor is directly liable for things such as giving inappropriate advice to their trainees or allowing their trainees to practice at a higher level than they are competent.
Why: This is the idea that as a license holder, if something happens it is on the supervisor.
EX: Janet was supervising a clinical counseling student and advised the student to implement EMDR, a therapy the student had not been trained in. Janet is directly liable for any harmful outcomes to the patient.

Question 9

Dual/Multiple Relationships

Answer 9

What: Dual relationships are when multiple roles exist between a therapist and a client. The therapist is either concurrently in another relationship with a client, concurrently in a relationship with a person closely associated with the client, or promising a relationship in the future. They are boundary crossings that refer to a situation in which multiple roles exist between a therapist and client. Examples of dual relationships are when the client is also a student, friend, family member, employee or business associate of the therapist.
Why: It is best to avoid multiple relationships if AT ALL possible because dual relationships affect the therapeutic alliance and/or disrupt the objectivity of the therapist. It compromises the integrity of the therapist-client relationship.
EX: Linda is a therapist and a client comes into therapy, she realizes in the first session it is her son’s basketball coach. She will refer him out to a colleague as this would be a dual relationship.

Question 10

Duty to Warn/Protect

Answer 10

What: Duty to warn means therapists have the responsibility to inform third parties if a client is at risk for harming themselves or another identifiable individual. The Tarasoff Case established that warning the authorities alone is insufficient and that the therapist must also warn the identifiable individual directly.
Why: One of the situations where the counselor is obligated to break confidentiality (client intent to harm themselves or intent to harm others).
EX: A client mentions he wants to kill his girlfriend this week, the therapist uses clinical judgment and calls the girlfriend and police to keep her safe.

Question 11

Ethics

Answer 11

What: Ethics are the standards that govern the conduct of professional members of a group or association, including therapists. The ACA and APA have a handbook of ethical codes that must be followed by all practitioners. Codes, laws, values, and morals might not align so, it is important to have a uniform set of rules, so everyone is held to the same standard with the same credentials.
Why: Ethical standards may conflict with morals, values, and even the law. Generally, ethics are a higher standard than what is required by law.
EX: The APA code of ethics dictates that therapists must wait two years following the termination of a therapeutic relationship to have a sexual relationship with clients, but it is legal to have a sexual relationship as long as clients have reached the age of consent.

Question 12

Ethical Boundaries in Clinical Practice

Answer 12

What: Although there is a set standard of rules that must be followed by counselors, there are times when a counselor has to cross a boundary as each client they are treating is not the same. A boundary violation is egregious and harmful and is not done in the interest of the client. A boundary crossing can be ethical if done in the interest of a client, it is possible it can be harmful or helpful but assessing the reasons for crossing a boundary is key before doing it
Why: These are boundaries which limit the nature of the therapist and client’s interaction in order to protect the relationship and the client’s well-being
EX: A therapist agrees to conduct a therapy session while walking because movement helps the client think and dispels some of the client’s anxiety about speaking honestly. This is a boundary crossing that benefits the client.

Question 13

Ethnic-Sensitive Practice

Answer 13

What: An ethnic-sensitive approach or practice is one that considers how the culture of a patient may impact their worldview, attitudes, beliefs, presentation of symptoms, or appropriate treatments. It involves an understanding of culturally-relevant insights and using this to develop interventions. Culture can affect a client’s behavior and will be seen differently in each client. It would be unethical to ignore issues like racism while working with minority clients. Practicing ethically leads to better outcomes.
Why: Counselors must be careful and self-aware enough not to apply their own worldview to the clients, but instead, attempt to understand their client’s worldview and the factors that influenced it.
EX: Tiffany is an Asian American client who often talks about her parents’ opinions of her choices in therapy. An ethnic-sensitive therapist will not be dismissive of these concerns but will understand that her worldview is collectivistic.

Question 14

HIPAA Compliance

Answer 14

What: Health Insurance Portability and Accountability Act. Requires the security and privacy of certain personal health information. This upholds a national standard of privacy for clients receiving treatment. Psychotherapy notes are protected under HIPAA and counselors should use technology to aid in this privacy
Why: A therapist must adhere to the HIPAA privacy and security rules in order to protect the information of the patient.
EX: A therapist notifies all new patients in the intake session that this is a HIPPA compliant service. All online documents are secured and will never be shared with an outside source

Question 15

Legal Aspects of Informed Consent

Answer 15

What: A therapist must discuss the limits of confidentiality, the nature of therapy, and the fee structure. In the context of clinical practice, there are three requirements that must be met in order for a person to give informed consent: capacity, comprehension, and voluntary. Capacity refers to the ability to make rational decisions; comprehension refers to understanding the material presented; and voluntary means that the client is not under any kind of compulsion. (The person giving consent must have the capacity to give consent, comprehension of relevant information, and the consent must be given in a voluntary nature without coercion)
Why:
EX: Cara comes to therapy and the therapist asks her some question before consenting to exposure therapy. She must understand what exposure therapy entails and understand the risk and benefits of it

Question 16

Licensure vs Certification

Answer 16

What: Licensure is a mandatory requirement to be a legal practitioner and is given out by a government board after rigorous education, training, and supervised practice. Certification is a voluntary process of acquiring knowledge and/or skills typically from a professional organization or association. Licensure is required by law and is given by a government-controlled board
Why: The license that one receives belongs to the issuing body because it is who a counselor reports to and holds them accountable. This means that it can be taken away if there is malpractice.
EX: Prior to beginning a private practice, Erin attended a graduate program, completed supervised internship hours, and sat for a licensure exam to ensure gained licensure from the South Carolina Board of Licensure and, therefore, be a legal practitioner. She also secured certification in TF-CBT.

Question 17

Malpractice

Answer 17

What: The failure of a counselor to provide the standard of care expected when treating an individual that results in direct damage to the patient. The 4 Ds - Duty(to protect client), Deviate(does practice deviate from normal tx), Damages (has this caused patient harm), Direct (does it directly affect the patient).
Why: may lead to legal action
EX: Administering a treatment one has not been trained to administer can result in malpractice. For example, if a patient presented with PTSD and a therapist who was not trained in EMDR administered that therapy.

Question 18

Morality

Answer 18

What: This is an individual’s internal values system for what is right and wrong and what constitutes right and proper conduct.
Why: In the same way that it is important for a counselor not to impose their values on their client, it is equally important that they do not impose their morality upon their client.
EX: A therapist believes that cheating on your girlfriend is wrong, but does not judge his client for cheating or try to convince him not to do it. The therapist recognizes that him viewing cheating as wrong is part of his morals. The client does not necessarily share these morals

Question 19

Peer Consultation

Answer 19

What: This involves engaging with other professionals in discussions about patients that provides guidance and expertise while maintaining confidentiality. The risks decrease and ethics of how you practice increase when involved in peer consultation. If a consultation does occur, you document and follow the advice given by the peer. Consultation allows counselors to ascertain that their biases are not influencing their decisions.
Why: Consultation is ESSENTIAL when using a risk management model and practicing ethically. This is important as a therapist’s peers can provide a fresh outlook on the situation with a client and provide an alternate perspective.
EX: Kate is a therapist dealing with a client who has bipolar disorder, there are a few options of treatments she is deciding between that would be best for her client. She uses peer consultation to discuss the potential options.

Question 20

Power Dynamics

Answer 20

What: Refers to the natural power differential between the clinician and the client. Related to therapeutic relationship; dynamic between therapist and client; natural power differential that exists between therapist and client- BOTH therapist and clients have power in various forms
Why: Ethical practice helps ensure that clients are not harmed or exploited through this power differential.
EX: Shaun is aware of the power dynamic between him and his clients. In order to lessen the effects of this uneven relationship, he explains the process and reasoning behind his techniques and is warm, empathetic and genuine.

Question 21

Privileged Communication

Answer 21

What: Aspect of certain professions that protects the confidentiality of communication, protects the counseling client from having to share information or a conversation that was shared with a counselor. It is protected by law from being shared with others, although there are some exceptions (duty to warn, suspicion of abuse, court order). The client has the privilege or right to determine if and when their protected communication is shared
Why: Protects not only the client but also the therapist.
EX: If a client shares that they have marijuana in their house, it is considered privileged information

Question 22

Pro Bono Service

Answer 22

What: Service that therapist provides for free, sometimes to members of the community who may not be able to afford their services. It is typically targeted to people that lack the resources as a means of access to mental health services.
Why: Counselors are highly encouraged and sometimes required per ethical mandate, to contribute to their community by providing pro bono services. It is important to establish boundaries and avoid allowing either party to take advantage of the situation
EX: A therapist keeps one afternoon of appointments available for pro bono services as a service to his community.

Question 23

Mens Rea

Answer 23

What: It involves a conscious disregard for the law, which is presumed to be known by the defendant. For some crimes, the mens rea may be recklessness or negligence rather than a deliberate intention to bring about certain consequences. Also called criminal intent. The malicious or blameworthy state of mind (Latin, “guilty mind”) that must be proved in addition to the actus reus to establish criminal responsibility and secure a conviction
Why: Important when deducing if someone is fit to stand trial/insanity.
EX:

Question 24

Professionalism

Answer 24

What: An obligation to behave in a certain manner and that the manner is within a certain ethics code, while permeating your life not just your practice. This includes appropriate dress and proper behavior when interacting with a client, and also encompasses appropriate behavior when in the community. One may be unprofessional without necessarily being unethical, but frequently the two are tied together
Why: professionalism is important for safeguarding the integrity of the client-therapist relationship.
EX: As part of professional practice, therapists should arrive on time, use respectful language, and dress appropriately.

Question 25

Reporting Child Abuse

Answer 25

What: Licensed therapists are mandated reporters and, therefore, required by law to report any suspected cases of child abuse to the proper authorities (DSS and the police) within 24 hours. This should be outlined in the informed consent process and discussed with the client when explaining the limits of confidentiality. Clinicians must report neglect or abuse of the elderly, the mentally handicapped, or anyone else that is vulnerable. Confidentiality is broken.
Why: If reported, it must be documented. Counselors who fail to report may be subject to legal and professional sanctions
EX: Brian has a client who is a 10 year boy and shares that his next door neighbor has been sexually abusing him. The therapist informs the parents and makes a call to DSS as well as the authorities.

Question 26

Self-Monitoring of Ethical Practice

Answer 26

What: This is the idea of constantly making sure you are making the right decisions and practicing within your scope. If you uphold the standards of the ethics code and focus on your job you should be okay. This is observed on a continuum and should be happening constantly. If you do something outside of your scope to generate revenue, this will be a violation of the code. Counselors should be aware of ethical codes and monitor themselves to ensure that they are practicing ethically. Counselors should not rely wholly on self-monitoring, and should also use peer consultations and reviews.
Why: Clinicians should be aware of what is outside their scope, and should constantly monitor to make sure they are practicing within it.
EX: A therapist accepts a gift offered by a client. Later, she considers her clinical decision and whether it was ethical. She feels confident in the self-monitoring of her behavior, but she reaches out to a colleague to ask for a second opinion anyway

Question 27

Sexual Intimacies with Former Clients

Answer 27

What: The ethical rules state that technically after 5-7 years it is ethical to have sexual intimacies with a former client. The amount of years depends on if you follow the ACA or APA. Therapists cannot end therapy with the promise of a future sexual relationship (constitutes a multiple relationship), and must ensure that there is minimal risk of harm to their former clients. JUST SAY NO.
Why: It is not illegal to do so but is generally unethical and should be avoided. It is important to take a conservative approach when dealing with the code of ethics
EX: Bruce ran into a former client, Cherie, many years after terminating therapy, and found her attractive. However, Bruce knew that Cherie had some tendencies towards borderline personality disorder, and decided that being sexually intimate with her could be harmful.

Question 28

Tarasoff Case

Answer 28

What: Therapists have a duty to protect third parties from violence threatened by their patients. Ruling requires that a therapist breach confidentiality in cases where the welfare and safety of a readily identifiable 3rd party is involved. When a client communicates a threat directed at an identifiable third party to their counselor and the counselor believes that the person is in imminent danger, they must warn the individual directly instead of simply alerting authorities.
Why: A psychologist was treating a patient who made a threat to kill an identifiable third party. Psychologist was unable to commit the patient and the patient killed the third party. The victim’s family sued; psychologists have a duty to warn/protect, which led to 1976 Tarasoff decision.
EX: Billy, an unstable individual whose therapist suspects of having a personality disorder, came in for a session and told the therapist he was planning on killing his wife that night. Due to the precedent established by the Tarasoff case, in addition to reporting the threat to authorities, the therapist had a duty to warn and protect the third party.

Question 29

Treatment of Minors

Answer 29

What: If someone is under age 17 they are a minor and can only assent to treatment, the parents or legal guardians must consent. The age of consent varies from state to state and is important information to know if treating a minor. The parent or guardians must be aware of what is going on in regards to treatment, and have access to the files, but do not get all of the information about what is said in the treatment room unless necessary to break confidentiality.
Why:
EX: A thirteen year old showed up at Teresa’s office asking for an appointment. After establishing that the child was not in crisis, Teresa explained that she could not see him without his parent’s consent, and gently suggested ways that he might talk to his parents about coming to therapy

Question 30

Values in Counseling

Answer 30

What: Values are beliefs and attitudes based on our culture and individual preferences that provide direction for everyday living. Therapists should be aware of their own values, attempt to understand their clients’, and avoid placing their own value system on the client.
Why: The counselor should be careful not to impose their values on their clients, but respect their client’s personal values system. The therapist should seek training or assistance in areas at which they are at risk of imposing their values onto clients especially when their values are inconsistent with the client’s goals or are discriminatory in nature.
EX: Linda was seeing a 25 year old single woman who was trying to decide whether to have a child or not, and Linda found herself almost discouraging the woman from having the baby. She realized that she was imposing her values (“unwed mothers are immoral”) on her client.

Question 31

Vicarious Liability

Answer 31

What: In the context of a supervisor/supervisee relationship, the supervisor is vicariously liable and legally responsible for any mistakes that their trainees make in their practice. Despite the fact that it is the trainee’s mistake, the supervisor assumes responsibility for it when they become a supervisor of that individual.
Why: It is good to consider when practicing ethically. This adds to the risk level of both the supervisor and counselor under their supervision.
EX: Ned is supervising a trainee who makes a mistake by agreeing to go on a date with a client who they claim is not severe and “could handle it.” Because Ned is supervising the trainee, he is vicariously liable for this mistake.